Getting Blotto with Otto

At the risk of turning my blog into a "Dear Abby" column for disaffected medicos, I am replying to Anonymous who writes:

Dear Sheepish,

A question for you: I asked my HMO3 today why he thinks women are more likely to develop a femoral hernia. He said that it is because the process of childbirth weakens the posterior wall of the femoral canal. I asked him to tell me an examination feature that would distinguish an incarcerated femoral hernia from a tender groin lymph node. He said that a patient with an incarcerated femoral hernia would have signs of a bowel obstruction and that a hernia is reducible.

I am not on call tonight.

My question is: How many alcoholic beverages should I consume tonight?

Unfortunately for you, Anonymous, however many drinks you have tonight, your poor HMO will still be there on Monday, oblivious to his ignorance and not having learnt a thing. You, however, will be hung over and barely functioning, and very much the worse for wear for your alcohol-fuelled binge.

If you plan on pursuing your surgical career, you need to decide on one of two paths.

1. Work out how much you can drink on a regular basis without anyone knowing the difference. This may take a fair bit of trial and error.
2. Realise that one-in-two or one-in-one on-call, will make frequent Toga Parties or Bond Nights a near impossibility, so perhaps it is time to give up or cut down now.

Personally, I have made it a point that I don't drink when I'm on-call, and at other times I'm limited to one drink at night with dinner. If I'm on holiday, then no restrictions apply. In reality, though, not being in the habit of drinking regularly I often just go without. There is not much point opening a bottle of wine when I know I'll be unlikely to finish it before it goes off - but that is just me.

I don't think that I am any more authoritative on this issue than anyone else - is it OK to drink when you are on call? Given that sleep deprivation for 24 hours is said to be as bad as having a blood alcohol level of 0.05, perhaps it's OK to have a few drinks if you get plenty of sleep? Stories abound about surgeons who operate while inebriated. Is an impaired surgeon better than no surgeon at all? Is an incompetent surgeon better than no surgeon at all? The Bundaberg experience would say no, and so would my MDO.

Perhaps next time, you should ask your HMO3 if he knows what a torsion of the testicle feels like. Or intermittent claudication of the arm. If not, you can always provide a demonstration.

Mind the Gap: Part 5 - GapCover

This is Part 5 of a series outlining the Australian Health Insurance industry from the perspective of a health provider.

5. GapCover

This type of scheme, which goes by many names from insurer to insurer (such as GapCover, No-Gap, EzyClaim, "Just Ask", MediGap, etc. etc), basically involves an agreement between the doctor and the insurer to avoid the patient paying out-of-pocket expenses. In effect it is a bulk-billing system for private health insurance. Insurance companies agree to pay the doctor directly, for an amount above the CMBS rate, with the doctor undertaking to limit or waive any out-of-pocket or gap expenses to the patient. This type of arrangement has long been in place with the Department of Veterans' Affairs (DVA), Victorian Transport Accident Commission (TAC), and WorkCover (previously WorkCare).

The doctor benefits if they did not charge large gap fees to begin with, as they get paid more than CMBS, and they do not have to worry about bad debts (often more than 10% of patients will not pay their bills).

The Government and the Insurance Companies look good because they have "eliminated gap fees". Even better, the insurance companies now have a means to limit future payments to doctors, because they can just make sure that the agreed rates rise at less than CPI, and in 10 years time they are underpaying doctors substantially and there is a community expectation that doctors cannot charge gap fees.

This has worked very effectively for Medicare's Bulk-Billing system for 20 years, and GapCover is merely a similar scheme to cap doctors fees in the longer term while providing a short-term enticement.

The erosion of Medicare benefits is one reason for increasing Gap Fees

• Canberra urged to ban gap fees
  
• Patients to be informed of gap payments

More on this series next week.

8 Random Things About Me

Milk & Two Sugars has tagged me with a blog meme. If you don't know, Wikipedia has lots to say about memes. I accept your tag, M&TS, so here are 8 (perhaps not-so) Random Things About Me.

1. I am not a fan of social viruses, of which I consider blog memes to be one. I particularly despise those emails that you get with a soppy story about how someone's life was magically improved by reading a poem and forwarding it to 5 other people.
2. I make it a point never to forward those emails onto anybody, and perhaps I have been cursed and will be struck down in the next week by 5 different fatal diseases, and die 10 times over - but I don't believe it so I don't care. Therefore, I won't be tagging anybody else with this meme. If you are the kind of person who gets excited by this kind of thing then go knock yourself out and join in.
3. When I get unsolicited phone calls from telemarketers I usually hand the phone to my incoherently babbling son.
4. When the above 3-year old had his teeth out under GA, he was narky for about 4 hours and then was perfectly fine after a sleep. In fact, he never complained about any pain, and was eating normally that evening.
5. I had my wisdom teeth removed under GA when I was studying at University. I was sore and bruised for 2 weeks.
6. My lower lip is still a bit numb from the inferior alveolar nerve injury.
7. I have a numb patch on my big toe.
8. I get queasy thinking about doing ingrown toenails, but I'm fine when I'm actually scrubbed.

How's that, M&TS?

Snail's Pace

Apologies to all for the recent lack of activity. I have recently uprooted the family and moved far, far away. Well, maybe just a time zone's difference.

In any case, in the madness of packing and unpacking, I lost my ADSL modem/router and therefore have been Internet-less for the last two weeks.

It's amazing what moving into an empty house, with no 21st-century conveniences can be like. While waiting for the moving van to arrive, I had a week with no kettle, fridge, or (even worse) television or internet. I was most upset that I had missed two episodes of 24, and at the lack of a nice hot cup of tea.

The upside is that I am much better at the Cryptic Crossword than I used to be, and I got plenty of sleep, what with having no screaming children, work, or really anything to do after sundown for the better part of a week. It was a bit like being on holiday on a beach resort, except that there was no beach, resort-style entertainment, or service of any kind.

However, it's all hands back on deck now, and back to normal programming soon.

It does make me think, though... if or when you finally manage to get away from it all, how do you occupy your time? The sudden lack of unexpected phone calls from hospital wards about inane matters, the disappearance of the need to be somewhere five minutes ago, the magical ignorance of the piling electronic and physical in-box. Do you find that you can do all the things that you meant to do but didn't have time, or that you realise that none of those things really mattered, and you are struggling to find something to waste your time with?

I know where I was for the last two weeks.